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European Journal of Cardio-Thoracic Surgery, Vol 9, 615-619, Copyright © 1995 by European Association for Cardio-thoracic Surgery
TA Orszulak, HV Schaff, JR Pluth, GK Danielson, FJ Puga, DM Ilstrup and BJ Anderson
All patients (285) undergoing mitral valve replacement (MVR) with a
Carpentier-Edwards (C-E) bioprosthesis +/- coronary bypass grafts (CABG)
were reviewed (109 men and 176 women with a median age of 70 years).
Overall, the 5-year survival rate was 58.9%, 62.7% for MVR (199 patients)
and 50.1% for MVR+CABG (86 patients). Late survival was adversely affected
by the operative time variables of NYHA class IV, older (> or = 70
years) age, low (> or = 56%) ejection fraction (EF), and the additional
performance of associated procedures+CABG with MVR (P < or = 0.001). The
5-year freedom from stroke rate was 89.2%, 89.1% for MVR and 90.2% for MVR
+/- CABG. Advanced heart class was the only significant variable associated
with a greater risk of late stroke (P < or = 0.01). Neither chronic
preoperative atrial fibrillation nor operative obliteration of the left
atrial appendage increased or decreased the late risk of stroke in patients
following MVR. Hazard function for stroke occurring in the first
postoperative year (first 48 h excluded to discount intraoperative events)
demonstrated the highest rate within the first month (40%), rapidly
diminishing thereafter. This pattern was reproduced in the 12-year hazard
function in that the rate of stroke occurrence was greatest in the first
year (6.7%) following implantation. The mean stroke rate over 12 years was
2.5%. Strokes following MVR +/- CABG are more likely to occur in older and
more compromised patients, and the higher early rate is not reflected in
the mean rate. A more aggressive approach to early anticoagulation with IV
heparin, Coumadin, and possibly antiplatelet therapy is advocated to reduce
this complication rate.
ARTICLES
The risk of stroke in the early postoperative period following mitral valve replacement
Section of Cardiovascular Surgery and Biostatistics, Mayo Clinic/Mayo Foundation, Rochester, MN 55905, USA.
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